A nurse is caring for a client who has AIDS. The client states, “My mouth is sore when I eat.” Which of the following instructions should the nurse provide?

Choice A reason: Starting work in a parking garage while on warfarin does not inherently indicate a need for referral unless specific risks (e.g., injury prone to bleeding) are present. Without additional concerns, this situation is routine, making it incorrect for requiring further care.
Choice B reason: Increased urinary frequency with bumetanide, a diuretic, is an expected side effect, not requiring referral unless severe or accompanied by electrolyte imbalances. This is a normal response, so it does not warrant further care, making it incorrect.
Choice C reason: An induration 48 hours after a Mantoux test suggests a positive tuberculosis result, requiring referral for chest X-ray and further evaluation. This finding indicates potential latent or active TB, a significant health concern, making it the correct choice for referral.
Choice D reason: Being 1 day postoperative after knee replacement is expected, with routine monitoring for complications like infection or thrombosis. Without specific issues, this does not require referral beyond standard postoperative care, making it incorrect.

Choice A reason: Financial power of attorney manages monetary decisions, not health care, unless specified as a health care surrogate. Advance directives guide health decisions, but this role is distinct, making this statement incorrect under the Patient Self-Determination Act’s provisions.
Choice B reason: The Patient Self-Determination Act ensures clients’ rights to refuse treatment, even against provider recommendations, promoting autonomy through advance directives. This legal protection applies in Medicare/Medicaid facilities, making it the correct principle for end-of-life decision-making in this context.
Choice C reason: Advance directives can be changed by a competent client, even if notarized, as the Act supports ongoing autonomy. Stating they cannot be altered is incorrect, as flexibility is a core feature, making this an inaccurate representation of the law.
Choice D reason: The eldest adult child cannot change advance directives unless designated as a surrogate. The Act prioritizes the client’s documented wishes or appointed decision-maker, not family hierarchy, making this statement incorrect and misaligned with legal requirements.